In 1989, the World Health Organization announced that facilitating innovations by encouraging professional curiosity in healthcare professionals was one of the objectives for healthcare quality assurance [1]. Such strategy of the WHO results from the fact that the impact on human resources is a highly effective method for quality assurance in medical care [2–4]. The health service staff professionalism provides extraordinary basis for improving the processes and results [5]. For its part, professional curiosity of the staff depends on psychological wellbeing, including the desire for personal growth [6].

Unfortunately, healthcare providers are a professional group at risk of psychological problems [7] due to high levels of stress and psychological disorders [8, 9]. Occupational well-being was studied in physicians [10–12] and nursing staff [13, 14] of various medical specialties. It was found that depression, being the worst manifestation of psychological ill-being, formed the basis for medical malpractice [13].

Heads of clinical departments are the key figures in healthcare quality assurance [15], that is why their psychological well-being is extremely important. Heads of clinical departments work as both clinical specialists and healthcare managers [15], i.e., increased workloads are coupled with the responsibility for directing the work of the entire department. These factors together with the requirements for mastering a wider range of competencies and professional development in both medical specialty and management can adversely affect the psychological well-being of this cohort of healthcare professionals.

The study was aimed to assess psychological well-being of the department heads at healthcare organizations.

METHODS

The study involved an online survey of residents who received the continuing professional education training at the Academy of Postgraduate Education of the Federal Scientific and Clinical Center of Specialized Types of Medical Care of FMBA in 2019–2021. Inclusion criteria: respondents holding a position of the head of clinical department. Exclusion criteria: unfinished questionnaires. The survey was conducted using the standardized Russian version of the Ryff's scales of psychological well-being adopted by Shevelenkova–Fesenko [16]. Such choice is explained by the fact that standard values of psychological well-being for four gender and age groups are provided in relation to this version. The questionnaires were sent to respondents by e-mail or incorporated in the training courses and posted on the distance learning platform.

The questionnaire includes 84 items with six scales: Positive Relations with Others, Autonomy, Environmental Mastery, Personal Growth, Purpose in Life, Self-Acceptance, and three integral categories, Affect Balance, Meaningful Life, Human Being as an Open System, which were scored separately. A 6-point Likert scale (1 — Strongly disagree, 6 — Strongly agree) was used to assess psychological well-being. Higher scores indicated better subjective well-being. This principle was applicable to all scales of the questionnaire and two integral categories (Meaningful Life, Human Being as an Open System). Lower scores in the Affect Balance category indicated better condition of the respondent.

Characteristics of respondents

The survey involved 216 respondents (tab. 1). Owing to the unavailability of data on the sampled population size, deterministic sampling method was used that was based on the expert judgement provided by the group of experts [17]. 

Characteristics were selected based on the third party research data on the impact of gender, age, increased workloads, better education and professional development on psychological well-being. It was thus suggested that increased workloads, experienced by the respondents working in inpatients settings and in the red zones, adversely affected their psychological well-being. We also assumed that the fact of having second higher education, qualification caregory, academic degree, that could be regarded as an indirect confirmation of the desire for personal growth, had a beneficial effect on psychological well-being.

The differences in years of service between men and women were significant: t = 7.44; р ˂ 0.001. There were significant differences in age and years of service between the respondents working in inpatient and outpatient settings: t = 6.87; р ˂ 0.001. At the time of the survey, more than half of the respondents worked in the departments that provided care to patients with coronavirus infection, where enhanced hygiene and infection prevention and control regime together with specific zoning (hereinafter, “the red zone”) were used. The differences in the average age and years of service between those who had an experience or no experience of working in the red zone were significant: t = 6.62; р ˂ 0.001. There were no significant differences in age (t = 0.648; р = 0.197) and years of service (t = 0.457; р = 0.095) between individuals assigned and not assigned a qualification caregory. The differences in age (t = 2.536; р = 0.012) and years of service (t = 1.987; р = 0.048) between the respondents having and not having an academic degree were significant. The differences in age (t = 0.123; р = 0.902) and years of service (t = 0.186; р = 0.853) between the respondents having and not having second higher education were non-significant.

Comparative analysis of scores was performed for three gender and age groups, men aged 20–35 and 36–55, women aged 36–55, where the standard values of psychological well-being were available. There were no women aged 20–35 among the respondents. The average psychological well-being scores were provided for the general group and five gender and age groups: men aged 20–35, 36–55, and over 56; women aged 36–55 and over 56.

IBM SPSS Statistics 23 software (IBM Company; USA) was used to calculate the mean, median, mode, standard deviation, percentage, Student's t-test, Pearson correlation coefficient. Correlations and mean differences for independent samples were considered significant at р < 0.05.

RESULTS

The mean score of psychological well-being on the Ryff's scales was 378.67 ± 78.33, median was 398.5, mode was 438.00; in 54 respondents (25%), the psychological well-being score was below 342.25, and in 54 people (25%) it exceeded 442.75. In 86 respondents (39.8%) the scores of psychological wellbeing were below average. The average levels of psychological well-being in women aged 36–55, men aged 20–35 and 36–55 exceeded standard values (tab. 2). However, in 26 men (26%) and 28 women (43.1%) aged 36–55, the levels of psychological well-being were below standard values.

The correlation of psychological well-being with age (r = 0.2; p = 0.019) and years of service (r = 0.2; p = 0.008) was revealed. There were no significant differences in the mean scores of psychological well-being between men (377.47 ± 81.13) and women (380.25 ± 74.87; t = 0.257, р = 0.798); heads of departments working in inpatient settings (376.38 ± 82.38) and primary health care institutions (381.37 ± 73.58; t = 0.466, р = 0.642); respondents having (379.63 ± 81.23) and not having second higher education (377.66 ± 75.51; t = 0.185, р = 0.854); those assigned (380.52 ± 78.06) and not assigned a qualification category (375.39 ± 79.21; t = 0.461, р = 0.645); those having (389.24 ± 68.48) and not having an academic degree (374.32 ± 81.86; t = 1.274, р = 0.204); those having an experience (378.20 ± 81.26) or no experience of working in the red zone (379.19 ± 75.32; t = 0.093; р = 0.926).

The mean scores for the categories and scales of the Ryff's questionnaire by gender and age groups are provided in tab. 2.

The mean scores in the categories Affect Balance and Meaningful Life were below standard values in all the surveyed gender and age groups. In 20 men (20%) and 17 women (26.2%) aged 36–55, the Affect Balance scores exceeded standard values.

The Meaningful Life scores were below standard values in 11 men (54.5%) aged 25–35, 60 men (60%) and 46 women (70.8%) aged 36–55. The mean scores in the category Human Being as an Open System were below standard values in women and men aged 35–55, but exceeded standard values in men aged 25–35. The scores in this category were below standard values in 2 men (18.2%) aged 25–35, as well as in 53 men (53.0%) and 41 women (63.1%) aged 36–55.

In the general group of respondents, the Affect Balance scores were above average in 88 people (40.7%), the Meaningful Life scores were below average in 88 people (40.7%), and the scores in the category Human Being as an Open System were below average in 95 people (44.0%).  

The mean scores on the Ryff's scales Personal Growth, Positive Relations with Others, Autonomy, Environmental Mastery, Purpose in Life, Self-Acceptance exceeded standard values in all the gender and age groups. The Personal Growth scores were below standard values in 3 men (27.3%) aged 25–35, 47 men (47%) and 15 women (23.1%) aged 36–55. The scores on the scale Positive Relations with Others were below standard values in 22 men (22%) and 23 women (35.4%) aged 36–55. The Autonomy scores were below standard values in 25 men (25%) and 16 women (24.6%) aged 36–55. The Environmental Mastery scores were below standard values in 25 men (25%) and 18 women (27.7%) aged 36–55. The scores on the scale Purpose in Life were below standard values in 28 men (28%) and 23 women (35.4%) aged 36–55. The Self-Acceptance scores were below standard values in 23 men (23%) and 24 (36.9%) women aged 36–55.

In the general group of respondents, the scores on the following scales were below average: Personal Growth in 93 people (43.1%), Positive Relations with Others in 103 people (47.7%), Autonomy in 77 people (35.6%), Environmental Mastery in 79 people (36.6%), Purpose in Life in 90 people (41.7%), Self-Acceptance in 99 surveyed department heads (45.8%).

There was a correlation of age and years of service with the scores in all categories and scales of the questionnaire (р ≤ 0.05), except the Self-Acceptance scale (р > 0.05). Age and years of service negatively correlated with the Affect Balance, and positively correlated with other categories and scales.

All the categories and scales of the questionnaire were intercorrelated (р ≤ 0.05), there was a negative correlation with the Affect Balance category. Based on some categories and scales of psychological well-being, there were no correlations between scores and gender, the fact of having second higher education, qualification category, or academic degree, the type of organization where the respondent worked, and the experience of working in the red zone (р > 0.05).

DISCUSSION

Psychological well-being of almost 40% of respondents scored below average. Since standard values of psychological wellbeing for all gender and age groups are not available, let is focus on the respondents aged 36–55, whose share in the age structure of department heads is the largest. Thus, 43.1% women and 26% men in this age group have psychological well-being scores below standard values. The results of survey that targeted this age group from the prospective of categories and scales reveals the variants of psychological ill-being.

Based on the Affect Balance category, almost a third of women and 20% of men aged 36–55 show life dissatisfaction, low assessment of their capabilities of learning and overcoming life's problems, poor skills of maintaining healthy relationships with others. Based on the scale Positive Relations with Others, more than a third of women and more than 20% of men have a propensity for privacy and distrust in relationships; based on the Personal Growth scale, more than 20% of women and almost half of men of this age group show no desire for selfrealization, cognition, behavioral changes.

Based on the Self-Acceptance scale, almost 40% of women and 20% of men aged 36–55 are concerned about poor personal characteristics, but are dissatisfied with their status in society in the perception of the surrounding world. That explains why 70.8% of women and 60% of men in this age group tend to perceive their life as meaningless and pointless based on the Meaningful Life category; more than a third of women and almost a third of men have no sense of purpose together with limited or no goals and aspirations based on the scale Purpose in Life.

Based on the category Human Being as an Open System, 63.1% of women and 53% of men aged 36–55 show a lack of willingness to make use of the experience gained and are reluctant to perceive adequately the realities of life. In addition, based on the Environmental Mastery scale,  more than a quarter of women and a quarter of men are unable not only to control things, but also to take advantage of emerging opportunities to implement changes; based on the Autonomy scale, a quarter of women and men show dependence on people around them and are prone to submissive behavior.

It should be noted that the findings are correlated with the data on poor professional competencies in the field of management in heads of medical organizations [18].

A survey of women deserves special attention. The groups of men and women showed similar levels of psychological well-being in general, and in certain psychological well-being categories and scales (р > 0.05). However, we would like to remind that psychological well-being scores in the age group 36–55 were below standard values in 26% of men and 43.1% of women. It should be noted that there were no women below the age of 35 among the respondents, while men of this age accounted for 8.9% of male respondents. On the contrary, there were 30.1% of women over 56 among the respondents of this gender, and men of this age accounted only for 9.6%. The number of women among the respondents over the age of 56 was more than two times higher than the number of men: 28 and 12, respectively, while in the population of the country the number of females per 1000 males increases from 1,067 between the ages of 35–55 to 1,233 between the ages of 56–60 (Rosstat, https://rosstat.gov.ru/folder/12781). That is, women become heads of departments later and less frequently (the average age of female respondents is significantly higher compared to male respondents; t = 7.44, p ≤ 0.001). We believe that there is discrimination against women concerning career progression. Our assumptions, that career inhibition and inefficient struggle against it result in lower psychological wellbeing among women, are in line with other studies [19–21].  

The decline in indicators of psychological well-being as a whole and in all the categories and scales in men over the age of 35 is one more interesting aspect of the study. It should be noted that the components of psychological wellbeing change with age: well-being decreases until midlife and increases in late life [22]. Detrimental changes in standard values are also observed in men over the age of 35, but to a lesser degree. However, Autonomy scores become even higher (tab. 2). In male respondents over the age of 35, mean levels of psychological well-being decrease to 58 points (≈14.0% of the level of 25–35 years). The most significant reduction in scores in terms of category is observed in the Affect Balance category: the score is reduced by 18 points (29.0% of the level of 25–35 years). The Autonomy and Environmental Mastery categories are the least affected: the score is reduced by 8 points (≈11% of the level of 25–35 years). The Meaningful Life score has decreased by 13 points (≈14.0% of the level of 25–35 years); the scores on the scales Personal Growth, Purpose in Life, Self-Acceptance have decreased by 11 points (≈15% of the level of 25–35 years), and the Openness and Positive Relations scores have decreased by 10 points (≈14.0% of the level of 25–35 years). 

We have found no effects of the other studied respondents' characteristics on their psychological well-being. We expected that increased workloads experienced by employees working in the res zones would have a negative impact on their psychological well-being. It can be assumed that the effects of increased workloads are alleviated by satisfaction from the growing sense of accomplishment, direct personal involvement in addressing a global health problem, realization of altruistic behavior, markedly positive attitude of the society [7, 8]. We also expected to find a positive correlation between psychological well-being and formal characteristics of professional development: second higher education, qualification category, academic degree. However, formal characteristics of professional development had no effect, even on the respondents' personal growth (qualification category, р = 0.990; academic degree, р = 0.430; second higher education, р = 0.686). At the same time, the fact that more than 40% of respondents have Personal Growth scores below average is a particular cause for concern, as the requirements for intense professional development of physicians and healthcare managers grow.

CONCLUSIONS

Although the average levels of the respondents' psychological well-being exceed standard values, the findings reveal several problematic aspects. First, high proportion of individuals with the scores of psychological well-being and its components below standard values was found in the group aged 36–55. Second, lower psychological well-being of women was noted in the studied group. Third, there was a significant decline in psychological well-being among men over the age of 35. The findings expand understanding of psychological wellbeing of the department heads and healthcare professionals. However, the features of psychological well-being discovered entail identification of the underlying cause. Furthermore, it is necessary to confirm no correlation of psychological wellbeing, especially personal growth, with formal characteristics of professional development and workloads. In this regard, further research in this area could be recommended, involving the expansion of certain gender and age groups included in the sample population and the use of a larger number of the respondents' characteristics, to develop fully fledged recommendations regarding personnel management of medical organizations.